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Medicaid Reform Managed Care Study . Interim Update. May 2013. Study Background. SEA0082 passed by Wyoming Legislature (2013) Requires WDH to explore the use of managed care for the Medicaid population

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Presentation Transcript
study background
Study Background
  • SEA0082 passed by Wyoming Legislature (2013)
  • Requires WDH to explore the use of managed care for the Medicaid population
    • “The department shall explore the use of managed care for all or a designated part of the Medicaid population, with the goal of delivering care of the same or better quality as currently delivered but at reduced cost. The managed care plan shall include identification of goals, outcome measurements and evaluation tools...”
        • See SEA0082 Section 1(a)(i)(D)
what is managed care
What is Managed Care?
  • No singular definition, a range of designs and tools
  • Approaches range from ‘no risk’ contracts to ‘full risk’ contracts
  • Can be tailored to population needs:
    • Urban areas may use full-risk, comprehensive managed care plans
    • Rural/frontier areas may only be able to support primary care case management approaches
    • Limited benefit plans can be applied to different populations for different services
          • SOURCE:
why managed care
Why Managed Care?
  • A successful model of managed care should meet the following goals:
    • Control costs
      • Health care costs growing faster than GDP
      • Reduce inappropriate use of services
    • Improve quality
    • Improve population health
    • Increase preventive services
managed care example designs
Managed Care: Example Designs
  • Primary Care Case Management (PCCM)
    • Ensures that enrollees have a primary care provider who receives a small monthly per capita payment (an administrative fee) to coordinate each enrollee’s care. All services are still paid on a fee-for-service basis.
  • Limited-benefit plans
    • Typically covers a single type of benefit, paid on a capitated basis.
  • Comprehensive risk-based managed care
    • Typically incorporates a health maintenance organization (HMO) model in which enrollees must use a network of providers. States pay on a capitated basis.
            • SOURCE:
managed care and long term care
Managed care and Long Term Care
  • High cost of long term care services to Medicaid
    • Medicaid programs are now more likely to consider managed care approaches to address this population
  • Goal of Integrating Long Term Care Services in Managed Care
    • Develop a person‐centered system of care that addresses range of individual needs by:
      • Safely decreasing institutional utilization
      • Improving clinical and quality outcomes
      • Building on consumer choice
wdh definition of managed care
WDH Definition of Managed Care
  • For the purposes of this study, ‘managed care’ is:
    • Any system of healthcare delivery that focuses on management of healthcare services with the intent to provide integrated and coordinated care at a lower cost.
  • This could be accomplished using various service delivery models and payment methods
    • Focus: those that will function well in a rural/frontier state
  • Currently, WDH is not focused on any one model
study purpose
Study Purpose
  • Purpose
    • To explore models and methods uniquely created to fit a State’s rural/frontier characteristics
    • To recommend a managed care model that delivers care of the same or better quality as currently delivered, at a reduced cost (only if feasible for Wyoming)
wdh plan part one
WDH Plan: Part ONe
  • Part 1
    • The chosen Consultant will:
      • Research models of managed care and payment methods
      • Conduct outreach to clients, advocates, providers
      • Provide recommendations to WDH about feasibility of various models in Wyoming ,including recommendations on:
        • most appropriate models of managed care
        • most appropriate payment methods
        • most appropriate categories of recipients, and
        • any combination thereof
      • Gather information from organizations interested in managing the care of the Wyoming Medicaid population
wdh plan part two
WDH Plan: Part Two
  • Part 2
    • The chosen Consultant will:
      • Research/analyze viability of specific benefits of any recommended models
      • The goal is to deliver same or better quality care at lower cost
wdh plan part two 2
WDH Plan: Part Two (2)
  • Part Two should provide answers to the following questions:
    • 1) Could costs be reduced, and if so, by how much and over what period of time?
    • 2) Could healthcare quality be maintained or improved, and if so for which measures?
    • 3) Could population health be improved and preventive services increased, and for which conditions?
    • 4) Could healthcare access and provider participation be maintained or improved?
wdh plan part three
WDH Plan: Part Three
  • Part 3
    • The chosen Consultant will:
      • Provide technical assistance and/or planning guidance to WDH in drafting final recommendations on use of managed care in Wyoming
      • If appropriate, provide technical assistance to the WDH in the creation of a high-level planning document
      • Be prepared to provide additional technical assistance on an as requested basis at an hourly rate
in depth stakeholder process
In-Depth: Stakeholder Process
  • Stakeholder input will be sought by Consultant during Part 1 of study
    • Clients
    • Advocates
    • Providers
  • Stakeholders will be asked to comment via survey and/or interviews on:
    • Features of managed care models that could work in Wyoming
    • Features of payment methods in a managed care structure
    • Viability of various models and methods in current provider structure
    • Impact of implementing managed care elements on clients and providers
    • Provider/client participation
managed care rfp
Managed Care RFP
  • WDH Study Team guided development of RFP
    • Deliverables include:
      • Work plan for study and related final report
      • Bi-monthly written updates/progress reports
      • Medicaid stakeholder outreach (online surveys, interviews)
      • Draft and final report of research and analysis of managed care models
      • Recommendations of managed care models for Wyoming
  • Released May 15, 2013
study time frame
Study Time Frame
  • Responses to RFP due June 5, 2013
  • Study will commence by July 15, 2013
    • 1-year contract
  • Anticipated completion: July 15, 2014
thank you
Thank you